Overview

NYC Department of Health and Mental Hygiene (DOHMH) Health eHearts (“eHearts” or healthy hearts), was an incentive program funded by the Robin Hood Foundation. This initiative rewarded and recognized several electronic health record (EHR)-enabled practices for achieving excellent heart health in patients. eHearts focused on improving cardiovascular health to produce the greatest impact on the health of New Yorkers. Unlike other pay-for-performance programs, eHearts use EHR-generated clinical quality outcomes and was designed to reduce health disparities.

Core Measures

Participating practices were enabled to transmit prevention-oriented quality measures derived from Take Care New York, the city’s health policy agenda, to the DOHMH. Practices in eHearts were randomized to receive rewards based on their performance on a core set of quality measures in cardiovascular health (the “ABCS”):

Blood pressure controlled to recommend levels in patients with hypertension

C

Cholesterol controlled to recommended levels in patients with hypercholesterolemia

S

Smoking cessation intervention or counseling for current smokers

Benefits to Providers

All participants received Quality Reports and Public Recognition

Quality Reports

Customized provider-level reports were distributed to each participating practice to help them track their progress and improve care. Quality Reports summarized provider and practice-level achievement (and areas for improvement) on the ABCS as well as comparisons to benchmarks. Quality reports were NOT shared publicly and did not contain patient-level data.
View a sample Quality Report (PDF).

Recognition

eHearts publicly recognized all participating practices for their hard work and commitment to providing excellent heart health, with special recognition for top performers in specified categories. Examples of recognition included a recognition event, press releases, and a Letter of Recognition signed by Health Commissioner Thomas Farley, MD.

Quality Incentives

A randomly selected group of participants received financial incentives to evaluate the impact of this innovative model on health outcomes. Final incentives were calculated based on ABCS goals achieved for each patient. Incentives were larger for high-risk patients with a priority insurance status (Medicaid or uninsured) or with an existing co-morbidity diagnosis (IVD or Diabetes).

The potential quality incentive payment to each participating practice is capped at $25,000 per quarter.

Evaluation

PCIP’s Health eHearts pay-for-quality program disbursed $4 million in incentives to EHR enabled providers that improved on a core set of quality measures related to cardiovascular health including aspirin therapy, blood pressure and cholesterol control, and smoking cessation (ABCS). Over 700 providers participated in the program and all practices saw improvement on the A, B, and S measures.
DOHMH aims to demonstrate the capacity and reliability of using EHR quality measure data as the basis for recognition and rewards programs. Some practices were asked to complete evaluation activities such as surveys, focus groups, and interviews.

NYC Health eQuits

With funding from the CDC Communities Putting Prevention to Work, the New York City Department of Health and Mental Hygiene’s Primary Care Information Project (PCIP) created a program to improve the rate of smoking cessation intervention, known as Health eQuits. Health eQuits was designed to pay for improvement above baseline, and offered modest compensation ($20 per intervention improvement). The program targeted large community health centers (CHCs) because they serve a higher proportion of Medicaid patients, which research suggests have higher rates of smoking. With a total funding of $360,000, the program aimed to ensure that an additional 1800 smokers got recommended smoking cessation interventions among the 19 large practices participating. Preliminary results include:

Average rates of tobacco counseling across participating community health centers increased from 28% of documented smokers received smoking cessation counseling from their providers to 53%, an addition of 47,705 smoking cessation interventions delivered.

The EHRs used by participating practices generated alerts to remind providers to document smoking status and council patients on smoking. Interventions included counseling by provider, prescription for cessation medication, or referral to NY State Fax to Quit.

New York Hotel Trades Council (NYHTC) and Hotel Association of NYC (HANYC), Inc. Employee Benefit Funds implemented eQuits with the most success. Preliminary results show a 30% overall quit rate and in one site, a combined 50% quit and smoking reduction rate. Their success was recently recognized at the event “NYC Celebrates Improved Health Through Technology” with Mayor Michael Bloomberg; Dr. Thomas Frieden, CDC Director; Dr. Thomas Farley, NYC Health Commissioner; and Dr. Farzad Mostashari, National Coordinator for Health Information Technology. Read more at www.nycreach.org